You’re in charge of managing your game plan from day to day (and hour to hour) because you’re the one who’s always there — to lace up your walking shoes, pour a bowl of bran cereal, take your medication, or prick your finger. But you’re hardly in this alone. In fact, one of your most important jobs as the manager — and boss — of your care is to line up a team of professionals to help you.
Your first stop is your primary-care physician, who probably diagnosed your diabetes. Your family doctor is a general practitioner (GP), not a diabetes specialist, but just because you have a specific disease doesn’t mean you’ll be bidding your regular doctor good-bye. In fact, GPs handle more than 90 percent of diabetes cases nationwide. That’s partly because the insurance industry funnels most care through GPs. But generalists are also well suited to handle a variety of health problems — valuable when dealing with a disease as multifaceted as diabetes — and they can readily refer you to a range of specialists when you need them. So consider your primary-care physician your right hand, but expect to draw on the talents of a wide range of experts, including the following:
This is a doctor who specializes in the management of diabetes, often with a board certification in endocrinology, the study of hormones and metabolism. A diabetologist will know more than your general practitioner about how to match your treatment to your blood-sugar, eating, and exercise patterns and is more likely to be up on the latest drugs and research. Talk with your GP about whether you need a diabetologist. If your main health problem is diabetes and you’re finding it difficult to control your blood sugar, a diabetologist should probably be calling the shots as your primary-care physician. If, on top of diabetes, you’re dealing with a range of other health problems, such as obesity, high blood pressure, or conditions not directly related to diabetes, you should stick with your GP and call your diabetologist when you have questions or issues your GP can’t address.
Your Diabetes Educator
The 15 minutes you get with your doctor won’t be enough to learn all the ins and outs of dealing with diabetes. That’s where a diabetes educator, usually a nurse with a special interest in diabetes care, comes in. She can show you how to prepare and administer insulin and perform blood and urine tests, explain how to balance your eating and exercise with your blood-sugar readings, and tell you more about how diabetes affects your body. She’s a walking diabetes library and may even offer classes on diabetes, at which you can get more background information and meet other patients. As such, your educator should have the right credentials. Look for the letters CDE — certified diabetes educator — after the name, which indicates that she has had special training in diabetes care and has passed an examination from the National Board for Diabetes Educators.
Controlling calories, counting carbohydrates, finding hidden fats, sorting out sugars, evaluating exchanges — your dietitian can help you with all of this. Meal planning (which involves everything just mentioned and more) is key to your care whether your main goal is to lose weight or to fine-tune your glucose intake. Usually a registered dietitian who may also be a certified diabetes educator, your dietitian will help you find both health and pleasure in what you eat by carefully matching your food to your drug or insulin use, your exercise habits, and your daily schedule. If anything about your treatment changes — or you get bored with your meal plan — your dietitian can help you adjust. Most of your contact with a dietitian will be at the beginning of your care, when you establish your meal plan, but checking in once or twice a year is a good idea.
Your Eye Doctor
Because diabetes is a leading cause of eye disorders and even blindness, you constantly need to guard against vision problems. The only person qualified to diagnose and treat eye damage from diabetes is an ophthalmologist — a medical doctor who specializes in the eyes. Don’t rely on checkups by an optometrist, who is qualified to do vision screening and prescribe glasses or contact lenses but isn’t an expert on eye diseases and can’t do surgery to correct them. Plan to visit your ophthalmologist at least once a year, but don’t wait for your annual exam if you notice changes in your vision or feel pain or pressure in your eyes — possible signs of damage that require immediate attention. When looking for an ophthalmologist, try to find one who specializes in diseases of the retina, especially if you’ve already developed eye complications.
Your Foot Doctor
High blood sugar makes you prone to foot problems partly because it hinders circulation: Blood has trouble getting all the way from the heart to the feet and back. Small sores and calluses, which are common with diabetes, can quickly become worse if you don’t keep on top of them with the help of a podiatrist — a medical doctor who specializes in foot care. Your primary-care physician should always check your feet when you go for an exam (and you should too, every day). But your podiatrist — known as a D.P.M., for doctor of podiatric medicine — is the best person to treat sores, calluses, corns, bunions, infections, or any other problem that may develop. He can also give you pointers on keeping your feet healthy. Ask your primary-care physician or endocrinologist to refer you to a podiatrist who has a lot of patients with diabetes.
As every cavity-prone eight-year-old knows (or will eventually find out), bacteria thrive on sugar. Unfortunately, if you have diabetes, high blood sugar makes you prone to the destructive effects of gingivitis — infection of the gums — even if you faithfully brush your teeth every day. There’s no reason to change your dentist if you have diabetes; you just need to make sure you actually go for a checkup and a cleaning every six months, as everyone should (but usually doesn’t). Do tell your dentist you have diabetes, however, and ask how you can improve your brushing and flossing techniques.
You may know your pharmacist only as someone who stands behind a counter and puts medicines in bottles. But don’t take this member of your team for granted. The special training that pharmacists receive about how drugs affect the body (in both good ways and bad) and how medicines interact with each other can make them an invaluable source of information. Try to find a pharmacist who works well with you; you may end up seeing this person more often than anybody else on your team. Then keep going back to the same pharmacy so the pharmacist can keep an up-to-date record of all your medications. Whenever you start a new drug — including over-the-counter remedies — or make a change in your prescriptions, your pharmacist can give you pointers on how your body may react. He can also give you a printout of all the drugs you take (along with their doses and side effects) to take with you when you see other members of your medical team.
Your Exercise Specialist
Your primary-care physician can approve an exercise plan, but he can’t be your coach. If you’re out of shape and haven’t exercised since the Reagan administration (or just want a trainer’s individual attention), you might want to design your fitness program with the help of an exercise physiologist. This person can custom-design a program that’s safe for you, help you set realistic goals, and give you pointers on proper form and technique. Your exercise specialist could be a doctor (in this case, a Ph.D.) but doesn’t have to be. You’re looking for someone with graduate training (preferably at least a master’s degree) in exercise science and a special interest in helping people with diabetes. She might be a certified diabetes educator or — ideally — someone certified by the American College of Sports Medicine. Start by asking your doctor to recommend a physiologist he’s worked with before.
Whether you need help handling the emotional aspects of diabetes is your call, but you should realize that it’s not strictly a mental-health issue. People who are angry, depressed, or anxious are more likely to neglect their care, so emotional support can, in effect, help stabilize your blood sugar as well as your mind and mood. You have three basic types of mental-health experts from which to choose. A psychiatrist is a medical doctor who has received advanced training in psychological disorders and can write prescriptions for drugs, such as anti-anxiety medications or antidepressants. A psychologist doesn’t have a medical degree (but usually has a Ph.D.) and can’t prescribe drugs, but he can help you recognize and overcome destructive or self-defeating ways of thinking. A social worker usually has less training in mental health (typically a master’s degree) but can help you cope with emotional troubles along with such practical challenges as dealing with insurance companies, hospitals, and government agencies.
Check out Diabetes Resources for information and support about living with, and preventing, diabetes.